Provider Demographics
NPI:1417427881
Name:TIMMYUNCLE, LLC
Entity Type:Organization
Organization Name:TIMMYUNCLE, LLC
Other - Org Name:COMFORCARE HOME CARE NE ORANGE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/OWENR
Authorized Official - Prefix:MR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DASTGHEIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-690-7431
Mailing Address - Street 1:2810 WARNER AVE APT 124
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-4421
Mailing Address - Country:US
Mailing Address - Phone:949-690-7431
Mailing Address - Fax:
Practice Address - Street 1:171 S ANITA DR STE 105
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3362
Practice Address - Country:US
Practice Address - Phone:714-831-0100
Practice Address - Fax:714-831-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care